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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6834 <br />TRAFFIC SIGNAL MODIFICATIONS: 17TH STREET AT ENGLISH STREET, <br />MACARTHUR BOULEVARD AT PLAZA DRIVE, EDINGER AVENUE <br />AT SULLIVAN STREET, WESTMINSTER AVENUE AT CLINTON STREET <br />FEDERAL PROJECT NO: HSIPL 5063(156) <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: 6.53% <br />Traffic Signal Modifications on: 17" St at English St, MacArthur Blvd at Plaza Dr, Edinger Ave at Sullivan, <br />3. Project Description: Westminster Ave at Clinton Sl <br />17t" St at English St, MacArthur Blvd at Plaza Dr, Edinger Ave at Sullivan, Westminster Ave at Clinton Sl <br />4. Project Location: in the City of Santa Ana <br />California Professional Engineering, Inc 7. Bide <br />5. Bidder's Name: 6. Prime Certified DBE: Amount: f <br />8. Total Dollar Amount for ALL Subcontractors. t ICAJ C'I1 _50 9. Total Number of ALL Subcontractors: <br />10. Bid <br />11Description of WorkServiceor Materials <br />. , , <br />12. DBE <br />13. DBE Contact Information <br />14. DBE <br />Item <br />Supplied <br />Certification <br />(Must be certified on the date bids are <br />Dollar <br />Number <br />Number <br />opened) <br />Amount <br />�— -4 <br />i� �' Ig rn' I Irw�t <br />Cl Cun <br />�J� �� 7 <br />CAA tt (0 2nt �i oFesn on <br />IYSi r nen G rr <br />r�eP 2lvl lVl( <br />I <br />vw-A1'z I CR ,q I l W <br />Local Agency to Complete this Section <br />21 Local Agency Contract Number <br />22. Federal -Aid Project Number <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />HSIPL 5063(156) <br />23. Bid Opening Date: <br />24. Contract Award Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />regardless of tier. Names of the First Tier DBE <br />Subcontractors and their respective item(s) of work listed <br />above must be consistent;'where applicable with the names <br />and item*f the work in the "Subcontractor List" submitted <br />Local Agency certifies that all DBE certifications are valid and information on <br />with your bl ,Zxltielr firmation of each listed DBE is <br />this form is complete and accurate. <br />room ed. <br />05/04/2016 <br />25. Local Agency Representative's Signature 26.: Date <br />16. eparer's Sip ture 1 Date <br />�26-810-1338 <br />Van Nguyen <br />18. Preparer's Narbe 19. Phone <br />27. Local Agency Representative's Name 28. Phone <br />President <br />29. Local Agency Representative's Title <br />20, Preparer's Title <br />DISTRIBUTION: 1. original —Local Agency <br />2, Copy — Caltrans District Local Assistance Engineer (DLAE), Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of <br />federal funds on contract. Include additional copy with award package. <br />ADA Notice: For Individuals with sensory disabilities, this document Is available In alternate formats. For information call (916) 654-6410 or TDD (916) 654-3080 or write Records <br />and Farms Management, 1120 N Street, MS -89, Sacramento, CA 95814. <br />P-27 of P-40 <br />150 <br />